Milestone House

Updated 20 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors.

Service and service type

Milestone House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Milestone House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 3 May 2023 and ended on 16 May 2023. We visited the location’s service on 3 May 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During our site visit we spoke to the registered manager on the telephone and home manager in person. We observed the staff and how they cared for people. We reviewed 3 people’s care plans, recruitment and training files for staff and documents such as rotas, meeting minutes and audits. We spoke to 6 people who lived at the home and 9 staff members including the registered manager.

Following our visit, we contacted 6 relatives of people who use the service and spoke to them about their experiences

Updated 20 June 2023

About the service

Milestone House is a residential care home for people living with learning disabilities and/or autism and physical disabilities. The care home accommodates 13 people in one adapted building and 10 people lived in the home at the time of the inspection.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service supported 10 people and was unable to demonstrate they all received good, individualised care to meet their needs.

People’s experience of using this service and what we found

Right Support: The service did not support people to have the maximum possible choice, control and independence over their own lives. Some people were supported by staff to pursue their interests. People had a choice about their living environment and were able to personalise their rooms.

Right Care: People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Some people benefitted from the opportunity to take part in activities and pursue interests that were tailored to them.

Right Culture: People and those important to them, including advocates, were not always involved in planning their care. Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate. The registered manager was not actively involved in overseeing the delivery of care to people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 8 April 2021). There were no breaches of the regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Milestone House on our website at www.cqc.org.uk

Enforcement and Recommendations

At the provider’s last inspection recommendations were made to seek guidance on reflective learning and personal behavioural support for staff. The registered manager and staff were unable to provide examples of reflective practice such as learning from complaints or accidents. Staff had completed appropriate training in personal behavioural support and clear guidance documents were available to assist them to identify when a person was in distress and how best to support them to de-escalate their behaviour.

We have identified breaches in relation to ensuring risks to people were safely managed. The registered manager failed to prevent, detect and control the spread of infections, staff had failed to ensure care and treatment needs of people were met. The registered manager did not have an established, effective and accessible system for managing complaints. They had failed to assess, monitor and improve the service, failed to maintain/keep accurate complete and contemporaneous records of care for each service user and failed to seek and act on feedback from relevant persons at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.